Self Harm
Ok, so you've probably got it in your head that only "emos" self-harm, right? Y'know, those teenagers with everything handed to them on a silver platter locking themselves in their rooms, moaning about how their lives suck so bad and writing bad poetry on MySpace? Well, actually self-harming is not particular to one social group - anyone can find themselves in a position whereby they can't cope and need some physical manifestation of their emotional pain. Even the "privileged" can get upset, y'know...
What is self-harm anyway?
Self-harm is a very broad term and it is often a way of communicating deep emotional pain when the self-harmer is unable to express with words what they are feeling. It has often been described as an "inner scream" - the sound you wish you could make out loud but never feel you can. Many people often feel better about things after a period of self-harm and can go for some time without the need to do it again. If someone self-harms, it can be their way of being able to transfer this inner pain into something on the outside that can be seen and dealt with; it acts as a release and can make the self-harmer feel as though they are dealing with their issues. A self-harmer is often worried , ashamed or afraid about what other people will think of them so they hide their behaviour by covering up exposed areas of the body that show evidence of self-harm and may even appear quite happy and cheerful to others on the outside in an attempt to avoid suspicion and detection. Self-harm can present in a lot of ways - not all of them immediately obvious - and here are just some of them:
- Scratching - this can vary from a persistent light scratching (commonly referred to as a "chicken scratch") until the skin is sore and broken or full-on digging in your nails until the skin is shredded and bleeding.
- Biting - usually the hands or arms are the area of choice, but if they can be reached, the legs, feet, stomach and shoulders.
- Hitting - either striking yourself with your hands or using objects such as books, tools, unopened cans of food etc. Can also be by hitting yourself against walls, doors and furniture.
- Overdosing - this is often quite a measured and calculated way of harming yourself as the aim is not to commit suicide. People may drink cleaning fluids, take more than the recommended dose of medication or take recreational drugs in large amounts.
- Poisoning - similar to overdosing, often household products like bleach are swallowed or a combination of fluids are mixed together and the fumes inhaled.
- Burning - often lit cigarettes or cigars are placed to the skin but also lighters and matches can be used - sometimes an open flame from a candle or fire instead.
- Cutting - common blades used are razors but scissors, knives and even serrated tools like saws and files can be used.
- Swallowing foreign objects - small toys, condoms filled with drugs or small items, nail files, ball bearings etc.
- Inserting foreign objects inside places like the ear, nose, anus and genital areas - see above items for examples.
- Developing an eating disorder such as anorexia or bulimia - this can take a long time to discover and sadly in a very few cases it is too late to save the self-harmer as major internal organ damage has already been done.
- Taking stupid risks - driving purposefully on the wrong side of the road, playing on railway lines, trying to run across busy roads/motorways etc.
- Becoming addicted to drink/drugs - developing a dependency on any substance is dangerous and despite the belief of the person addicted to something, they cannot control it - it controls them.
Like I say, these are just a few ways that someone can self-harm and not all of them are easily detected. Self-harmers will go to great lengths to ensure their behaviour is not found out and if you are concerned about someone you know self-harming then it won't be easy to find out the truth or to get them to admit it is a problem.
Why in the hell would someone need/want to self-harm??
Why indeed - and we're going to look at this properly so you can fully understand it. As a former self-harmer, I can identify with anyone who hurts themselves in one form or another in order to cope with a distressing situation. The first thing I need to point out is that the last thing a self-harming person needs is someone telling them they are attention-seeking and being ridiculous. This emphasises their initial belief that no one gives a toss and could even encourage them to go to greater lengths or refuse to seek help.
For some people, it is a reaction - compulsive behaviour as a result of something traumatic, distressing or disturbing. For others, it is something they think about often, even when they are calm and relaxed, and may even plan their next harming episode in advance. For many people they will have no idea why they do it and a few who aren't even trying to combat emotional strain - it's almost like a habit and has no definite reason.
It could be that someone is unable to tell others about an incident and self-harming is the only way to express their inward turmoil and pain. Or they could be hating themselves for something and see self-harm as a "punishment"; it could even be an expression of what they wish someone else could suffer for something they have done to the self-harmer. Self-harm may also be used to gain some control over their lives as is often the case with those who struggle with an eating disorder. Self-harm can even be a comfort to some people - something they are familiar with and can gain reassurance from.
A few people may even self-harm to direct pain away from another area of the body - for example, someone going through a painful drug withdrawal may well hit themselves, burn themselves with cigarettes or pound a fist or their head against an object in an attempt to make that pain more intense than their withdrawal symptoms. Or perhaps someone has a painful condition which medication cannot manage; it is not uncommon to find that people will hurt themselves to transfer their brain's attention from the condition to the new site of pain.
Now I know there will be some of you out there, shaking your heads and tutting at the "crazy" people who so clearly need to get their act together. Well let me tell you this - we all have our ways of coping and you can be damn sure that you have yours. Maybe you are so "well adjusted" that you can let stuff just glide over you and never affect you, but let me ask you something. How many times when you've had a stressful day have you come home to open a bottle of wine or can of beer? Or maybe your first reaction to bad news is to light a cigarette or punch a wall? Perhaps you lose your temper and storm out of the house, get in your car/on your bike/whatever transport you use and purposefully zoom off, driving carelessly even just for a little while before you calm down? Whilst you may not be in the same league as someone who gets out the bread knife and slices into their arms until they feel better, your course of action can be just as destructive. Like I said, we all have our ways of coping - just some of us need a little extra help admitting that there may be a better way of expressing our feelings. And I'm not just referring to self-harmers here...
How can I help someone who is self-harming?
It can be an awful shock to discover that someone you know and care about is hurting themselves. You may feel angry, guilty, sad or even just numb and out of your depth. However, first reactions are important and whilst the instinct may be to shout and cry and start throwing blame around like confetti the best thing to do is try to remain calm and compassionate. If there are fresh wounds visible, attend to them so that the self-harmer knows you care about their body and what happens to it. Do not ask how or why just yet - reassure them that you care and be aware of your facial expressions and body language as they will be studied closely by the person you are treating. If they need hospital care, explain this to them and try to encourage them to allow you to accompany them to hospital.
Be gentle with any questions you may have - do not interrupt, judge or try to explain anything during the time when they are speaking. Let them have room to really talk about what's going on and don't be impatient if nothing seems to make much sense if they keep repeating themselves. It is likely the only person they have ever spoken to about this is themselves, so be sensitive and careful. You most likely will want to know everything immediately but be patient - it takes a great deal of courage to admit to self-harming and you don't want to destroy this very delicate balance of trust.
Another temptation will be to try and "fix" everything there and then - please try to hold back as it can appear as though you are taking control; the self-harmer may well be hurting themselves to gain control and for someone to come in and rob them of that could do more harm than good. Let them decide whether they want your input or not and don't be hurt or offended if they'd rather talk to someone other than you. They are not trying to hurt you and probably won't even be able to see your pain beyond their own.
DO NOT BE CRITICAL, JUDGEMENTAL OR DISMISSIVE - often self esteem is incredibly low and the best thing you can say is anything that highlights the good points in their lives. It is unlikely they will accept what you are saying, but keep trying as the longer you keep saying it, the more chance there is of the self-harmer realising that you do mean it. Quite often they will try to explain any positive comments by saying that you are only telling them this or that because you are a friend or relative - this is common and again, they are not trying to hurt you. They may just want some regular and consistent affirmation of the good things before they can believe that they are true.
Most importantly, be normal - don't walk on eggshells around the person and try to avoid checking up on them, asking them how they are fifty times a day and do not invade their privacy without their permission such as going through personal items, reading letters/texts/emails or questioning their friends. Give it time and if it gets too much, seek help from one of the following organisations which can give you further assistance and professional advice:
How can I help myself?
If you can, confide in someone you trust - a friend, relative or partner. Perhaps contacting one of the above organisations will help and I encourage you to also visit our forums where you can chat in complete safety. If you prefer, you are more than welcome to contact us and talk in private about what you are struggling with. Many organisations and counsellors will not just address the issue of self-harm but will also dig a little deeper into why you started and what can be done to help you in the long term.
If talking to people makes you want to run a mile, then why not try relaxation techniques such as deep breathing or doing something which is calming like reading or having a hot bath. Honestly, it might sound like a crap idea but it can work for some people. This will sound odd too, but I find that when I am tempted to cut myself I get out the games console and play a game where I can smash things up - dunno why, but it relaxes me. You might find the same sort of thing works for you too.
Maybe go for a walk or listen to music - lyrics that might sound depressing to other people may actually make you feel that someone else can identify with you and is singing your pain. I'm the first to break out the Linkin Park when I get fed up with life in general and it does make me feel better.
In your calmer moments, have a think about why you are so angry. Get it down on paper or make something that expresses your feelings. One thing I did when dealing with my history of mental and sexual abuse was get a huge sheet of paper and cover it in cut-outs from newspapers and magazines - I picked the ugliest words I could find and most disturbing images I could lay my hands on and stuck them down on this piece of paper. Again, might sound a bit mental but it was easier to pinpoint the source of my emotions once I could read it in black and white. You might find writing songs, poems or a journal/diary can help you get things in perspective a bit better - might not make for easy reading, mind you, but too often we keep stuff in our heads until it is bigger than it actually was in the first place and reading your experiences and feelings back to yourself can let you see whether there is something you need help with or not. Writing a letter detailing everything someone has done wrong to you and then tearing it up or burning it can help too - although you may want to write several letters over and over again until you feel the benefit of this.
Do things you enjoy - however trivial you may think they are - and build up your self-esteem by showing off your skills. You may think you don't have any, but if you can paint a picture, write a story or make some music then showcase it to people and enjoy the praise. If you can skate or do stunts on your bike, for example, then go down the local park and show off - even if no one is there, you can pretend you are competing at a world-class level and go nuts. If you can face it, get down the pub with some mates and play pool or sing karaoke together.
If you really need to express your rage and anger, get some cushions, soft toys or something breakable which doesn't matter (you can get really cheap plates or cups for this purpose - or even get a load of china or something from a car boot sale or bargain basement) - then line them up and punch, kick, throw and stamp to your heart's content. Take out your feelings on something that can't feel and imagine they are the people who have hurt you. I had a friend at school who couldn't get on with her sister so her mum made two dolls with their names on and all the limbs and head attached with Velcro. When they had a row, they'd storm off to their respective rooms, slam the door and proceed to rip the arms and legs off their "sister". Quite therapeutic, actually...
If you feel you want to harm yourself, try to do something else - put some music on, watch a film, go for a walk, tidy up - anything to distract you from hurting yourself. If you really can't help yourself, then focus on doing it as safely as possible - don't cut too deep or too hard; if you swallow substances then go for something non-toxic. The aim is to minimise the damage and risk to your body because you will get better one day and with the right help, you'll be able to overcome this period of your life and you don't want to have to deal with irreparable damage to internal organs or your skin. I have ugly, jagged scars all over my arms and I hate them - there are a number of products on the market which can camouflage skin damage or can help to repair the skin over time, but they tend to be quite expensive and the best thing to do is try to minimise the chances of scarring in the first place by not cutting, biting, scratching or burning too hard. Don't pick at any healing wounds as this can cause scarring too and keep wounds as clean as possible. A good GP will advise you on the best way to care and treat yourself at home and may also, with your agreement, be able to refer you to someone who can help you overcome the desire to self-harm. Don't forget that anything you say to your GP is confidential.
Moving on...
Combating self-harm can be a long and difficult road - but it is not impossible. You may even find that you stop doing it gradually over time without any intervention whatsoever but if you are at all worried, then please get in contact with one of the organisations I listed earlier and they will be able to help you further. Don't be ashamed or worried if you find yourself harming again after many months or years of not even thinking about it - just remind yourself that you managed once and you can do it again. I tell that to myself almost every day and so far I have been free of harming myself for almost a year. Doesn't mean I don't sometimes think about it - but I do manage to find something else to do instead, which to me is over half the battle already won. And do not let others make you feel worse about yourself - too often we can make snap judgements about a person and not realise the true cause of their distress - there have been times I when have been criticised for admitting my self-harm by people who look at my husband and child and decide I have nothing to be upset about. Those sorts of people are morons and you don't need their "support and advice" - as far as I'm concerned, they have more of a problem than I do. At least I can admit when something is wrong in my life, even if I don't always deal with it in the best way.
Don't be hard on yourself and give it plenty of time - you're going to beat this and then be able to help others in the same situation. Definitely something to be proud of, eh?